Effectiveness of Digital Counseling Environments on Anxiety, Depression, and Adherence to Treatment Among Patients Who Are Chronically Ill: Systematic Review

Patients' perspectives of the digital counselling competence of healthcare professionals-A qualitative descriptive study

AIM

To describe the perspectives of patients using digital services on the digital counselling competence of healthcare professionals.

DESIGN

A descriptive qualitative interview study.

METHODS

The analysed data were collected in Finland during the spring of 2023 via 11 individual, semi-structured interviews from participants who had received video-mediated counselling. The interviews were carried out online through Microsoft Teams and adhered to an interview guide using main and ancillary questions. The data were analysed using inductive content analysis.

RESULTS

The patients' perspectives of healthcare professionals' digital counselling competence were related to five categories: (1) competence in preparing for video-mediated counselling, (2) digital competence in implementing the video-mediated counselling, (3) competence in interacting with the patient during the video-mediated counselling, (4) competence in supporting the patient's self-management in video-mediated counselling and (5) competence in self-development as a digital counsellor.

CONCLUSION

The results of this study indicate that healthcare professionals need to possess a wide range of digital counselling competencies when providing video-mediated counselling. This study thus lays the groundwork for future studies of patients' perspectives of healthcare professionals' digital counselling competence.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

The results of this study can be used to develop healthcare professionals' digital counselling competence and patient-centered care. The presented insights can also be used to map further research topics.

REPORTING METHOD

The Consolidated criteria for reporting qualitative research (COREQ) checklist was used when reporting the results.

PATIENT OR PUBLIC CONTRIBUTION

Patients who had experience in using digital services participated in the data collection of this study.

IMPACT

What problem did the study address? Healthcare professionals may well need to develop new competencies as counselling is increasingly moving to digital environments. What were the main findings? The main areas of digital counselling competence that emerged from the patients' perspectives were competence in preparing for video-mediated counselling, digital competence, competence in interacting with the patient, competence in supporting self-management and competence in self-development as a digital counsellor. Where and on whom will the research have an impact? The research can be used to build and develop healthcare professionals' digital counselling competence, as well as improve the delivery of patient-centered care.

Designing and evaluating a mobile app to assist patients undergoing coronary angiography and assessing its impact on anxiety, stress levels, and self-care

BACKGROUND

Coronary artery disease is one of the leading causes of death and disability worldwide. Coronary angiography is a diagnostic procedure used to detect atherosclerosis. Patients typically experience anxiety and stress before and during the angiography procedure. Furthermore, self-care ability is crucial following angiography.

AIM

This study aims to describe the design and evaluation of a mobile application focusing on stress, anxiety, and self-care abilities in patients undergoing coronary angiography.

METHOD

The researchers developed a mobile application for patients undergoing angiography. The application provides information about angiography and tips for enhancing self-care following the procedure. An interventional study was conducted on 70 patients admitted to the angiography ward in hospitals in Kerman, Iran, between 2022 and 2023. The participants were randomly divided into two groups: control and intervention. The interventional group received the intervention application the night before angiography. Two groups completed the Anxiety and Stress Questionnaire (DAS) and Kearney-Flescher Self-Care Survey before the intervention. The researchers used questionnaires that had been prepared and previously utilized in other studies. The two groups completed the anxiety and stress questionnaire within three to six hours and the self-care questionnaire one month after angiography. SPSS 15 software was used for data analysis, with a significance level set at 0.05.

RESULTS

The study found that the majority of participants were women. Before the study, there was no significant difference between the two groups in terms of anxiety, stress, and self-care scores. However, after the study, the intervention group showed a significant decrease in average anxiety and stress scores (p < 0.001). Additionally, compared to the control group, the intervention group demonstrated significant improvement in average self-care score (p < 0.001).

CONCLUSION

According to this study, AP can be effective in influencing the anxiety, stress levels, and self-care ability of patients who undergo coronary angiography. It can help to reduce stress and anxiety while increasing self-care. Instructive software is user-friendly, cost-effective, and can be recommended by nurses and doctors.

Digital Psychotherapies for Adults Experiencing Depressive Symptoms: Systematic Review and Meta-Analysis

BACKGROUND

Depression affects 5% of adults and it is a major cause of disability worldwide. Digital psychotherapies offer an accessible solution addressing this issue. This systematic review examines a spectrum of digital psychotherapies for depression, considering both their effectiveness and user perspectives.

OBJECTIVE

This review focuses on identifying (1) the most common types of digital psychotherapies, (2) clients' and practitioners' perspectives on helpful and unhelpful aspects, and (3) the effectiveness of digital psychotherapies for adults with depression.

METHODS

A mixed methods protocol was developed using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The search strategy used the Population, Intervention, Comparison, Outcomes, and Study Design (PICOS) framework covering 2010 to 2024 and 7 databases were searched. Overall, 13 authors extracted data, and all aspects of the review were checked by >1 reviewer to minimize biases. Quality appraisal was conducted for all studies. The clients' and therapists' perceptions on helpful and unhelpful factors were identified using qualitative narrative synthesis. Meta-analyses of depression outcomes were conducted using the standardized mean difference (calculated as Hedges g) of the postintervention change between digital psychotherapy and control groups.

RESULTS

Of 3303 initial records, 186 records (5.63%; 160 studies) were included in the review. Quantitative studies (131/160, 81.8%) with a randomized controlled trial design (88/160, 55%) were most common. The overall sample size included 70,720 participants (female: n=51,677, 73.07%; male: n=16,779, 23.73%). Digital interventions included "stand-alone" or non-human contact interventions (58/160, 36.2%), "human contact" interventions (11/160, 6.8%), and "blended" including stand-alone and human contact interventions (91/160, 56.8%). What clients and practitioners perceived as helpful in digital interventions included support with motivation and accessibility, explanation of task reminders, resources, and learning skills to manage symptoms. What was perceived as unhelpful included problems with usability and a lack of direction or explanation. A total of 80 studies with 16,072 participants were included in the meta-analysis, revealing a moderate to large effect in favor of digital psychotherapies for depression (Hedges g=-0.61, 95% CI -0.75 to -0.47; Z=-8.58; P<.001). Subgroup analyses of the studies with different intervention delivery formats and session frequency did not have a statistically significant effect on the results (P=.48 and P=.97, respectively). However, blended approaches revealed a large effect size (Hedges g=-0.793), while interventions involving human contact (Hedges g=-0.42) or no human contact (Hedges g=-0.40) had slightly smaller effect sizes.

CONCLUSIONS

Digital interventions for depression were found to be effective regardless of format and frequency. Blended interventions have larger effect size than those involving human contact or no human contact. Digital interventions were helpful especially for diverse ethnic groups and young women. Future research should focus on understanding the sources of heterogeneity based on intervention and population characteristics.

TRIAL REGISTRATION

PROSPERO CRD42021238462; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=238462.

Segmenting Patients With Diabetes With the Navigator Service in Primary Care and a Description of the Self-Acting Patient Group: Cross-Sectional Study

BACKGROUND

The aim of patient segmentation is to recognize patients with similar health care needs. The Finnish patient segmentation service Navigator segregates patients into 4 groups, including a self-acting group, who presumably manages their everyday life and coordinates their health care. Digital services could support their self-care. Knowledge on self-acting patients' characteristics is lacking.

OBJECTIVE

The study aims are to describe how Navigator assigns patients with diabetes to the 4 groups at nurses' appointments at a health center, the self-acting patient group's characteristics compared with other patient groups, and the concordance between the nurse's evaluation of the patient's group and the actual group assigned by Navigator (criterion validity).

METHODS

Patients with diabetes ≥18 years old visiting primary care were invited to participate in this cross-sectional study. Patients with disability preventing informed consent for participation were excluded. Nurses estimated the patients' upcoming group results before the appointment. We describe the concordance (%) between the evaluation and actual groups. Nurses used Navigator patients with diabetes (n=304) at their annual follow-up visits. The self-acting patients' diabetes care values (glycated hemoglobin [HbA1c], urine albumin to creatinine ratio, low-density lipoprotein cholesterol, blood pressure, BMI), chronic conditions, medication, smoking status, self-rated health, disability (World Health Organization Disability Assessment Schedule [WHODAS] 2.0), health-related quality of life (EQ-5D-5L), and well-being (Well-being Questionnaire [WBQ-12]) and the patients' responses to Navigator's question concerning their digital skills as outcome variables were compared with those of the other patients. We used descriptive statistics for the patients' distribution into the 4 groups and demographic data. We used the Mann-Whitney U test with nonnormally distributed variables, independent samples t test with normally distributed variables, and Pearson chi-square tests with categorized variables to compare the groups.

RESULTS

Most patients (259/304, 85.2%) were in the self-acting group. Hypertension, hyperlipidemia, and joint ailments were the most prevalent comorbidities among all patients. Self-acting patients had less ischemic cardiac disease (P=.001), depression or anxiety (P=.03), asthma or chronic obstructive pulmonary disease (P<.001), long-term pain (P<.001), and related medication. Self-acting patients had better self-rated health (P<.001), functional ability (P<.001), health-related quality of life (P<.001), and general well-being (P<.001). All patients considered their skills at using electronic services to be good.

CONCLUSIONS

The patients in the self-acting group had several comorbidities. However, their functional ability was not yet diminished compared with patients in the other groups. Therefore, to prevent diabetic complications and disabilities, support for patients' self-management should be emphasized in their integrated care services. Digital services could be involved in the care of patients willing to use them. The study was performed in 1 health center, the participants were volunteers, and most patients were assigned to self-acting patient group. These facts limit the generalizability of our results.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.2196/20570.

Telemedicine treatment of patients with mental disorders during and after the first COVID-19 pandemic lockdown in Germany - an observational study on feasibility and patient satisfaction

INTRODUCTION

In response to the COVID-19 pandemic, a general lockdown was enacted across Germany in March 2020. As a consequence, patients with mental health conditions received limited or no treatment in day hospitals and outpatient settings. To ensure continuity of care, the necessary technological preparations were made to enable the implementation of telemedical care via telephone or video conferencing, and this option was then used as much as possible. The aim of this study was to investigate the satisfaction and acceptance with telemedical care in a heterogeneous patient group of psychiatric outpatients in Germany during the first COVID-19 lockdown.

METHODS

In this observational study, patients in ongoing or newly initiated outpatient psychiatric therapy as well as those who had to be discharged from the day clinic ahead of schedule received telemedical treatment via telephone. Data collection to assess the patients' and therapists' satisfaction with and acceptance of the telemedical care was adjusted to the treatment setting.

RESULTS

Of 60 recruited patients, 57 could be included in the analysis. 51.6% of the patients and 52.3% of their therapists reported that the discussion of problems and needs worked just as well over the phone as in face-to-face consultations. In the subgroup of patients who were new to therapy due to being discharged from hospital early, acceptance was higher and telemedicine was rated as equally good in 87.5% of contacts. Both patients and therapists felt that telemedicine care during lockdown was an alternative for usual therapy in the outpatient clinic and that the option of telemedicine care should continue for the duration of the coronavirus pandemic.

DISCUSSION

The results show a clear trend towards satisfaction with and acceptance of telemedicine care in a heterogeneous group of unselected psychiatric patients. Although the number of patients is small, the results indicate that the mostly positive results of telemedicine concepts in research projects can probably be transferred to real healthcare settings.

CONCLUSIONS

Telemedicine can be employed in healthcare for psychiatric patients either an alternative treatment option to maintain continuity of care or as a potential addition to regular care.

The quality of long-term counselling for percutaneous coronary intervention patients: A cross-sectional study

AIM

To compare the long-term counselling quality among the patients visited and not visited at cardiac nurse after percutaneous coronary intervention (PCI) and related factors one to two years after PCI.

DESIGN

An explorative, register-based cross-sectional study.

METHODOLOGY METHODS

A sample was drawn from the one university hospital's procedure register consisted of the patients undergone a PCI (n = 977). The data was collected by Counselling Quality Instrument (CQI) questionnaire by mail, and analysed by basic and multivariate methods.

FINDINGS RESULTS

Of the respondents (n = 459), less than half the patients (48.4%) visited at cardiac nurse one to two years after PCI as instructed in the national current care guidelines. Patients, who visited the nurse (n = 194) had higher satisfaction for counselling than the ones not visited (n = 70). Nevertheless, patients, especially those who had no dyslipidemia, had Unstable Angina Pectoris or Non-ST-elevated myocardial infarction or were out of the workforce, were unsatisfied with counselling, and needed more social support, patient-centred counselling and goal orientating implementation from the cardiac nurse. A half of the PCI patients (51.6%) did not visit the cardiac nurse at the primary health care.

PATIENT OR PUBLIC CONTRIBUTION

Cardiac nurses assisted the members of research group by assessing the questionnaire prior sending it to the patients and patients contributed by completing the questionnaires. We thank both parties for their contribution.

IMPLICATION FOR PROFESSION AND PATIENT CARE

This study demonstrated, that patients out of the workforce and having emergency PCI are in need for better quality counselling, concentrating on social support, patient-centred counselling and goal orientating implementation from the cardiac nurse. Those patients, who did not visit the cardiac nurse, should be offered easier access to cardiac nurse for example, by novel digital solutions.

Prevalence of Depression and Related Factors among Patients with Chronic Disease during the COVID-19 Pandemic: A Systematic Review and Meta-Analysis

The management of chronic diseases in the midst of the COVID-19 pandemic is especially challenging, and reducing potential psychological harm is essential. This review aims to determine the prevalence of depression during the COVID-19 pandemic in patients with chronic disease, and to characterize the impacts of related factors. A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The meta-analysis was performed using StatsDirect software. The review identified 33 articles with a total of 50,905 patients with chronic diseases. Four meta-analyses were performed to estimate the prevalence of depression. In diabetic patients, the prevalence ranged from 17% (95% CI = 7-31) (PHQ-9) to 33% (95% CI = 16-51) (PHQ-8); in obese patients, the prevalence was 48% (95% CI = 26-71); and in hypertensive patients, the prevalence was 18% (95% CI = 13-24). The factors significantly associated with depression were female sex, being single, deterioration in the clinical parameters of diabetes, a decrease in self-care behavior, reduced physical activity and sleep time and fear of contagion. The COVID-19 pandemic has significantly increased levels of depression among persons with chronic disease. Pandemics and other emergency events have a major impact on mental health, so early psychological interventions and health management policies are needed to reinforce chronic patients' physical and mental health.